Endothelial dysfunction, intima-media thickness and coronary reserve in relation to risk factors and Framingham score in patients without clinical atherosclerosis.

BACKGROUND: Endothelial dysfunction, decreased coronary flow reserve (CFR) and increased intima-media thickness (IMT) are related to atherosclerosis and can be assessed non-invasively by echography. OBJECTIVES: In order to describe the relationship between these parameters and with cardiovascular risk, this study investigated them simultaneously in patients without clinical atherosclerosis. METHODS: A total of 106 subjects were studied, 91 with and 15 without cardiovascular risk factors. Cardiovascular disease was excluded in all cases. Doppler ultrasound was used to analyse endothelium-dependent vascular dilation in the brachial artery, IMT in the common carotid artery and CFR in the left anterior artery. RESULTS: Patients with cardiovascular risk factors had impaired flow-mediated dilation (FMD; 3.7 +/- 3.2 versus 11.6 +/- 4.4%, P = 0.000); greater IMT (0.89 +/- 0.3 versus 0.56 +/- 0.14 mm, P = 0.000) and lower CFR (2.7 +/- 0.9 versus 4 +/- 1.2, P = 0.000). Correlation was found between IMT and FMD r = -0.240, (P = 0.013), IMT and CFR, r = -0.384 (P = 0.000), and between FMD and CFR of r = 0.289 (P = 0.007). All patients with IMT greater than 1 mm showed depressed FMD, most of them with low values of CFR, but patients with reduced FMD or CFR did not necessarily show increased IMT. There was a significant correlation between the three parameters and the Framingham risk score. Multiple linear regression analysis showed that IMT was the only factor related to the Framingham score. CONCLUSION: In patients without clinical atherosclerotic disease, cardiovascular risk factors are associated with impaired FMD, CFR and increased IMT. Even though a correlation between these changes was found, they showed different dependence on cardiovascular risk factors and with global risk, IMT being the best correlated with the Framingham score.

[Noninvasive assessment of the effect of atorvastatin on coronary microvasculature and endothelial function in patients with dyslipidemia]. / Determinación no invasiva del efecto de atorvastatina en la microvasculatura coronaria y la función endotelial periférica de pacientes dislipémicos.

INTRODUCTION AND OBJECTIVES: The effect of statins has been monitored mainly in peripheral arteries. It is now possible to study coronary microcirculation by analyzing coronary reserve with transthoracic echocardiography. The aim of this study was to use this noninvasive technique to evaluate the effect of atorvastatin on peripheral endothelial function and on the coronary microvasculature in patients with dyslipidemia. PATIENTS AND METHOD: We included 21 patients with dyslipidemia but no clinical antecedents of atherosclerosis. Mean (SD) age was 64.9 (11) years, and women made up 61.9% of the group. All patients were treated with 20 mg atorvastatin during 3 months. Lipid profile, carotid intima-media thickness, endothelium-dependent vasodilation and coronary flow reserve were determined at baseline and at the end of treatment. All studies were performed with echocardiographic techniques. RESULTS: Together with improvements in the lipid profile, we found a 43% increase in endothelium-dependent vasodilation (4.3 [4.4] to 6.2 [3.8]; P=.07) and a 25% increase in coronary flow reserve (2.5 [0.6] vs 3.1 [0.8]; P=.002). The increase in endothelium-dependent vasodilatation correlated with age (r=-0.60; P=.004), intima-media thickness (r=-0.47; P=.029), low-density lipoprotein level before treatment (r=-0.43; P=.05), and baseline endothelium-dependent vasodilatation (r=-0.63; P=.002). The increase in coronary flow reserve correlated with low-density lipoprotein level after treatment (r=-0.51; P=.04). CONCLUSIONS: Short-term treatment with atorvastatin improved the lipid profile, coronary microvascular function and endothelium-dependent vasodilation in the peripheral circulation. The noninvasive assessment of coronary reserve is feasible with transthoracic echocardiography.

[Endothelial dysfunction and intima-media thickness in relation to cardiovascular risk factors in patients without clinical manifestations of atherosclerosis]. / Asociación de la disfunción endotelial y el grosor mediointimal carotídeo con los factores de riesgo coronario en pacientes sin evidencia clínica de aterosclerosis.

INTRODUCTION: Endothelial dysfunction and increased intima-media thickness are early findings in the development of atherosclerosis that can be assessed non-invasively by echography. The aim of this study was to investigate endothelial function and intima-media thickness, and the relation between these processes and cardiovascular risk factors in patients without clinical atherosclerosis. PATIENTS AND METHOD: Fifty-two subjects were studied, 39 with one or more cardiovascular risk factors and 13 with none. Vascular echography was performed to analyze endothelium-dependent vascular dilatation in the brachial artery and intima-media thickness in the common carotid artery. RESULTS: Compared to patients without risk factors, patients with cardiovascular risk factors more frequently had impaired vascular dilatation after ischemia, 11.98 4.61% vs 2.77 2.57%, (P<.0.001; mean difference = 9.21%, 95% CI of the difference 6.33-12.07%) and a greater intima-media thickness, 0.085 0.024% vs 0.057 0.014 cm (P < 0.0001; mean difference = 0.028 cm, 95% CI of the difference, 0.017-0.04 cm). There was a significant negative correlation between intimal-media thickness and endothelial dysfunction (r = -0.357; P<0.01). Linear regression analysis showed that intima-media thickness was independently related to age and the presence of hypertension, while endothelial function was related only with the presence of hypertension, smoking, and hyperlipoproteinemia. CONCLUSIONS: In patients without clinical atherosclerotic disease, cardiovascular risk factors were associated with impaired endothelial function and increased intima-media thickness. There was a negative correlation between endothelial-dependent vascular dilatation and intima-media thickness.

Asociación de la disfunción endotelial y el grosor mediointimal carotídeo con los factores de riesgo coronario en pacientes sin evidencia clínica de aterosclerosis / Endothelial dysfunction and intima-media thickness in relation to cardiovascular risk factors in patients without clinical manifestations of atherosclerosis

Introducción y objetivos. La disfunción endotelial y el aumento del grosor mediointimal carotídeo son fenómenos tempranos en el desarrollo de la aterosclerosis, que pueden estudiarse de forma incruenta por ecocardiografía. Se pretende analizar la función endotelial, el grosor mediointimal carotídeo y la correlación entre ambos parámetros con los factores de riesgo coronario en pacientes sin evidencia clínica de aterosclerosis. Pacientes y método. Se incluyeron 52 sujetos, 13 sin ningún factor de riesgo coronario y 39 con al menos un factor de riesgo coronario. Se les realizó una medición ecocardiográfica de la vasodilatación dependiente del endotelio en la arteria braquial y del grosor mediointimal en la carótida común. Resultados. En comparación con los sujetos sin factores de riesgo coronario, los pacientes con factores de riesgo presentaron una disminución de la vasodilatación dependiente del endotelio: 11,98 ñ 4,61 por ciento frente a 2,77 ñ 2,57 por ciento, (p < 0,0001; diferencia de medias del 9,21 por ciento con un IC del 95 por ciento de 6,33-12,07), y un aumento del grosor mediointimal carotídeo de 0,085 ñ 0,024 cm frente a 0,057 ñ 0,014 cm (p = 0,0002; diferencia de medias de 0,028 cm con un IC del 95 por ciento de 0,017-0,04). Se obtuvo una correlación estadísticamente significativa entre el grosor mediointimal carotídeo y la vasodilatación dependiente del endotelio (r = -0,357; p < 0,01). En el análisis de regresión lineal múltiple, el grosor mediointimal carotídeo dependía de la edad y de la presencia de hipertensión arterial, mientras que la vasodilatación dependiente del endotelio lo hacía de la presencia de hipertensión, tabaquismo y dislipemia. Conclusiones. En pacientes sin evidencia clínica o complicaciones ateroscleróticas pero con factores de riesgo coronario, la función endotelial es peor y el grosor mediointimal carotídeo es mayor que en pacientes sin ellos. Además, existe una asociación lineal negativa entre la vasodilatación dependiente del endotelio y el grosor mediointimal (AU)